Which Stent Should I Insert? Medicated or Non-medicated?

First of all, let’s try to answer what is the process of stenting (stenting) in the coronary vessels. It is the placement of a metal structure called a stent as part of the process called angioplasty (angio-like) into the coronary vessels that feed the heart. Stents are high-tech metal (mostly steel, cobalt) structures that are braided like a cage, but whose mesh shapes are designed as a result of long studies to give the most appropriate result, very thinned, then subjected to special polishing processes. The purpose of placing the stent inside the vessel is to reduce the risk of re-narrowing or occlusion of that part of the vessel. This process can be likened to the process of supporting (for example, concreting) the wall to prevent collapse after a tunnel is drilled.

With the use of stents, coronary interventions have become much safer for the patient, and the rate of narrowing of the vessels has decreased, resulting in the need for re-intervention.

In our country, as in the rest of the world, drug-free (bare metal) stents were used until a few years ago. In the last 3-4 years, a new stent group has emerged in the world and therefore in our country. These stents, unlike previous generation stents, are stents that release the loaded drug into the vein. Medicated stents (more precisely, drug-eluting stents) reduce the rate of re-narrowing of the vessel compared to drug-free stents, thanks to the drug they release after they are placed on the vein. Because, as a result of both the natural occlusion process of the vein and the healing process of the trauma caused by the intervention to the vein, there is always the risk of re-narrowing and occlusion of the treated veins.

Today, medicated stents are preferred in more than 90% of coronary interventions in the USA. Thanks to its intensive use in the last 3-4 years, our knowledge about medicated stents is increasing. In this way, some points are drawing more and more attention in the use of medicated stent, which seems to almost eliminate coronary bypass surgery. Bare metal stents (without drugs) become a part of the vein by being covered by the vascular structures in a short time after they are placed into the vein. It is reported that this period can be very long in medicated stents. Therefore, it is necessary to use special drugs for a long time (between 3 months and 2 years) against the risk of clot formation on the stent in people who have a medicated stent placed. It is recommended that people who will not or cannot use this type of drugs stay away from medicated stents. The second point is that medicated stents reduce the risk of re-narrowing of the vessel compared to non-medicated stents, but the risk never goes down to “0”.

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